Reply: Complex PCI in severe aortic stenosis: high risk, low reward?

We sincerely appreciate the interest in our article “Outcomes of complex, high-risk percutaneous coronary intervention in patients with severe aortic stenosis: the ASCoP registry”1 shown in the Letter to the Editor by Ktenopoulos et al2. We agree with the authors about the need to balance the procedural risk of these patients against the anticipated clinical benefit that could be achieved after percutaneous coronary intervention (PCI). Patients who have severe aortic stenosis and concomitant coronary artery disease often present more comorbidities and challenging vascular access that translate into a higher risk of complications during transcatheter aortic valve implantation (TAVI) and/or PCI. Data from randomised trials and real-world registries considering this high-risk population reported a high rate of events (particularly bleeding, vascular complications, and acute kidney injury), with a significant increase in their incidence if TAVI and PCI were both performed345. The results of our registry, considering an even higher-risk population, confirmed previous evidence.

As is correctly pointed out by Ktenopoulos et al, one of the reasons that might justify the high rate of adverse events (vascular complications...